Sometime within the past five years, the University of Minnesota School of Dentistry found itself in good company. Like the Law School, School of Pharmacy, Veterinary School, and Medical School, the School of Dentistry had an incoming class comprised of more than fifty percent women. William E. Stein, D.D.S., Executive Editor of Northwest Dentistry, wrote in the November-December 2009 issue of this journal that, “Now the classes are evenly divided male and female as it should be.”
Minnesota exceeds the national average of women in professional programs as reported by the Office of Institutional Research at the University of Minnesota-Twin Cities (please see graph).
The American Dental Association references the Health Policy Resources Center, which reported: “The relative proportion of women in dentistry has increased from less than three percent of practicing dentists in 1970 to more than 14 percent in 2002. By 2020, women are projected to make up about 30 percent of active dental practitioners. The American Dental Association’s Future of Dentistry report concluded that the major demographic shift in the number of female dentists will affect dental work force trends in the United States throughout the first decades of this century.”
A review of advertising placed in this publication over the past year provides a snapshot of the trends. According to Patty Lien, the Advertising Manager for the Northwest Dentistry Journal, the classified advertising section of the journal is filled with maternity leave coverage needs, often for the dentist/owner or dentist/employee.
Yesterday and Today
Dental professionals are often so motivated to excel that they have not always been as smart about work/life balance. In the past, personal lives and family lives took a backseat to school and work. It was not uncommon for students in training to put off getting married or having children, all the while moving across the country for a residency or specialty training. That is no longer the case. There are now a variety of options available for students during their professional training. The trend includes the following exercises in flexibility.
• Having a baby? Maternity leave is fine. We’ll see you next semester.
• Staying home with a newborn for a year. Switching off with the other parent, who takes a year out from his professional training to stay home for the second year is now an available and acceptable option.
• Taking a year off from pursuing a Master’s degree to achieve other personal goals is considered not only “no problem”, but an enhancement.
• Choosing a residency in a specialty that will allow a family to stay within the same metropolitan area so as not to disrupt a spouse’s job and/or children’s school settings happens all the time.
Policies at professional schools are changing, and professional practices reflect this in their practice patterns. A study of the Washington Dental Service (WDS), Seattle, in the Journal of the American Dental Association reported:
“The authors found no differences between male and female dentists in the number of procedures per patient, income per patient, or income per day of work. Frequency distributions of various services were highly similar for both groups. Multiple regression models showed no influence of dentist’s sex on total income. However, the mean and median numbers of days worked were about 10 percent lower for female dentists than for male dentists. This difference was consistent with the finding that female dentists treated approximately 10 percent fewer patients, performed about 10 percent fewer procedures, and had a combined income of about 10 percent less than that of male dentists.”
It is gender bias to say that work/life balance is an issue unique to women. Men are starting to understand that flexibility is a good thing, too. The article goes on to say, “In general, female dentists worked fewer days per year than did their male counterparts. Both groups demonstrated flexibility in work schedules on the basis of age, family responsibilities, and other life choices. Such flexibility is a relatively rare and positive aspect of a career in dentistry for men and women.”
To underscore the success of a healthy work/life balance philosophy for men and women, this author can speak from personal experience. When I started my staffing business 21 years ago, it was to allow me to leave the clinical world to accommodate the needs of my family and to provide that same opportunity to our temporary staff. At first, most of our employees were women, but pretty soon the men saw the benefits and joined in the process. By creatively exploring these options, now men who want to see their practices grow and thrive are also able to enjoy the work/life balance that channels energy into all their goals, both personal and professional.
Managing the needs of personal lives and professional lives is always a challenge. Flexibility in a professional practice is difficult at best. Baseline wisdom is that the key to a profitable professional practice is to keep a full schedule: See that extra patient; schedule an extra half hour; shorten the lunch break; open a little earlier in the morning; create later hours after corporate work hours.
Dentistry is a challenging profession. It is the only health care specialty in which the practitioners perform surgery on a daily basis. It is not just a professional career, it’s physical. In addition to procedural work, there is the expectation that the practitioner will supervise the staff, and even when a dentist does not own the practice, he or she is supervising a team.
When a dentist does own the practice, you can add that old adage, “That’s when things really get interesting”. Procedural work must continue to evolve, with the owner having the greatest interest and investment in performing at optimal levels to improve/increase profitability and stay clinically current. Within the business and clinical aspects of the practice, it becomes yet a further challenge to recruit, hire, train, supervise, and manage staff; manage the financials; create and implement marketing plans; work with all the vendors for supplies, equipment, and software; and deal with medical billing issues. If there are problems with payments, cash flow, whatever you wish to call it, suddenly you are in the business of collections. Problems with insurance changes? Better start creating new products and services to offset lower reimbursements. It’s still buzzing when you get into bed at night: When do you find time to develop a relationship with your banker? Go to human resources conferences to make sure you’re managing things legally? And don’t forget about your need for ongoing professional education! It goes on and on, but inevitably comes back to the central figure, the dentist him- or herself. Some dentists report struggling with their own health care issues related to “trying to do it all”. The hard fact is that when a dentist cannot work, the revenue stream can suffer, and financial problems can exacerbate an already overtaxed individual.
The previously quoted ADA article states that “Female and male dentists provided a similar range of services and earned an equal income per patient treated and per day worked. However, women worked fewer days per year than did men, irrespective of age. If the dental work force and practice patterns remain unchanged otherwise, the total number of patients treated per dentist will decrease slightly as women make up an increasing proportion of dentists.” When shortages occur among professionals, the professionals have an advantage regarding choices about their work time, flexibility, and incomes. This provides opportunities for dentists to find the settings that work best for them.
When women need time off for maternity leaves, child care, or family time management, it can be tough on a practice. To replace a qualified clinician who has dedicated patients and who will be using earned vacation, sick, and disability time, while having to pay to replace her, is expensive. There are other costs inherent in self-managing replacement, among them recruiting, training, and creating a trial for a new practitioner, someone who may not fit with the existing staff or who may not click with patients.
There is a “good news” side to the challenges of the new work environment as it evolves to accommodate the lives we want to live now. Stressed dental professionals can explore a number of options that can help stabilize a practice under these new conditions. For instance, women now expect a new paradigm when they become pregnant. No longer do they say, “Can I afford to get pregnant and have to worry about my job?” Now the formula goes something like, “I’m going to get pregnant, and I will make it work, even to the point of finding a new job.”
Practices will enjoy improved retention by providing flexibility. Dedicated staff will stay, and return to practices that demonstrate support of work/life balance. Maintaining patient caseloads with flexible work schedules will take extra coordination. But there are options.
One option for handling the new flexibility scenario for a practice is to outsource the management of its non-clinical areas. Look for an experienced group that understands the business side of dentistry. While the dentist/owner will still have final approval of all decisions, he or she can bring in people with their own professional expertise to do such things as:
• create and implement a marketing program
• recruit professional staff
• implement and follow through on human resources issues and policies
• deal with vendors, billing, collections, and paying the bills.
Use your time as owner to do what you do best: provide quality clinical care, keep up on your professional education, and increase revenue. If you are not distracted by all the business details, think of the revenue potential that exists for your practice.
Outsourcing can provide many benefits. Group buying discounts can save so much that it alone can justify outsourcing management. A practice management resource that understands human resources can assure that your practice is managed professionally and save you money by reducing the potential for litigation. Having a strong financial resource can sort out reimbursement complexities quickly and increase cash flow.
Locums and Direct Hire
Another option is to bring in locum tenens and temporary staff when there are maternity and other leaves that occur. Having a stable staffing plan is essential for patient and staff retention to meet the practice revenue goals. Many practices find that locums are highly qualified professionals who bring strengths to their practices. They often have varied skills from operating in many settings. Being adept at stepping into new and different settings increases the likelihood that they will “fit in” and will be effective in maintaining patient retention. As well, they can bring new specialties to a practice to build revenue.
Find the Experience
Remember the men who now like flexibility, too? Some will be selling their practices soon, but they still want to work part-time. They often enjoy working as locums and are able to bring practice management skills as well. Having a locums tenens in the practice or working with a search firm for direct hire of a new dentist gives a practice the freedom to make sure the individual’s personality and skills are well matched to the practice. Having a staffing firm find the right match in a timely way and be there to deal with rapid replacement of mismatches if needed avoids the pitfalls that may go with hiring a friend to fill in, which can become awkward and stressful for everyone in the practice if it does not work out. Letting a friend go usually takes a lot longer, and it can have a high cost, with damage to retention of patients and other staff, and ultimately, to revenue.
The new face of dental professionals is creating new and different challenges. Women understand that they can’t “do it all”; no one can. They already understand outsourcing because they outsource a lot of their lives: child care when they’re working, home management to other help, practice management to the practice owner, or office management to their hired staff if they own the practice. Outsourcing practice management that includes financial management, billing, staffing, human resources, and benefit management makes sense in this new environment. As the demands of the dental profession increase, no one has the time to keep up on all these areas.
It is a truism that many women go into health care to help people. Some want to run their own show; some never intended to own a business. But all of them want to do something good, utilize the skills they worked so hard to attain, have hours that are workable to raise their own families, and make a decent living doing it. Practices that provide flexible work schedules, part-time opportunities, and benefit mixes that accommodate fewer hours will be those practices that will be in demand, have better staff retention, and ultimately, higher revenue. Owners that outsource non-clinical areas to professionals that are skilled in those areas will also benefit financially.
The future of dentistry is in good hands as the face of the dental profession changes. Practice transition consultants Loren Swanson and Mike Haase report that women are buying practices at an unprecedented level. Loren Swanson says, “Being a dentist is the best job in the world. They have the opportunity to create their own future by running their own show, make a handsome living, and have the opportunity to help people. What can be better than that?”
1. American Dental Association. Future of dentistry. Chicago: American Dental Association, Health Policy Resources Center; 2001:35-38.
2. del Aguila, M et al. Practice patterns among male and female general dentists in a Washington state population. J Am Dent Assoc, Vol 136, No 6, 790-796. © 2005
3. Office of Institutional Research at the University of Minnesota-Twin Cities, 2008 Measurement of Progress, June 2009
*Judy Goldetsky, M.A., is CEO/Founder of On Call Clinicians, Inc., a medical and dental staffing/search firm and dental practice management company in Minneapolis, Minnesota, and Executive Director of Doorstep Healthcare Services, a non-profit that provides dental, therapy and hearing services to underserved populations in Minnesota.